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Intrusion |
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Immature root formation: ¨ Mild intrusion (less than 3mm), leave to re-erupt and review ¨ Moderate intrusion ( 3mm to 6mm) may re-erupt or require orthodontic repositioning ¨ Severe intrusion (6mm+) consider surgical repositioning under LA. Bony impactions may require release of impediment prior to repositioning the labial plate and soft tissue closure and suturing. ¨ Monitor radiographically at 3, 4 and 6 weeks.
Mature root formation: ¨ Mild intrusion (<3mm) may be orthodontically repositioned over a period of about 2 weeks ¨ Moderate intrusion (3—6mm) reposition orthodontically ¨ Severe intrusion (6mm+) surgical repositioning and appropriate tissue repair carried out at a specialist centre. ¨ Extirpate the pulp 2 weeks after injury, using calcium hydroxide as an interim dressing to inhibit root resorption ¨ RCT once periodontal healing established. The optimum time for this is 2 weeks after injury.
Prognosis: ¨ The nature of the crush injury to the periodontal membrane and root surface is quite severe and progressive root resorption is commonly seen. Figures vary from 38% to 52%. ¨ It is important that the tooth should be sufficiently repositioned within 3 weeks to allow treatment of necrotic pulps and thus minimise the risk of inflammatory root resorption. |
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Intrusion is caused by an axial, apical impact and results in extensive damage to pulp and periodontal ligament |